Provider Demographics
NPI:1861971509
Name:SHANNON, CAMERON S (DPT)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:S
Last Name:SHANNON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 MCCAIN BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7607
Mailing Address - Country:US
Mailing Address - Phone:501-758-5555
Mailing Address - Fax:501-758-5941
Practice Address - Street 1:2504 MCCAIN BLVD STE 230
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7607
Practice Address - Country:US
Practice Address - Phone:501-758-5555
Practice Address - Fax:501-758-5941
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist